Provider Demographics
NPI:1396069357
Name:JACOVIDES, VALERIE (RN,MSN,FNP-C)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:JACOVIDES
Suffix:
Gender:F
Credentials:RN,MSN,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 W GUADALUPE RD STE 111
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3321
Mailing Address - Country:US
Mailing Address - Phone:480-366-4490
Mailing Address - Fax:480-854-3618
Practice Address - Street 1:81 W GUADALUPE RD STE 111
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3321
Practice Address - Country:US
Practice Address - Phone:480-366-4490
Practice Address - Fax:480-854-3618
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN090279363LF0000X
AZAP3641363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ711771Medicaid